Chemoradiotherapy With or Without Metformin in Locally Advanced Cervical Cancer

Cervical Cancer Clinical Trial

Official title:

Phase II Randomized Window of Opportunity Trial of Chemoradiotherapy Alone Versus Combination With Metformin in Locally Advanced Cervical Cancer

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06353061
• Other study ID #: LACC-MET
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: April 15, 2024
• Est. completion date: February 1, 2026

Study information

• Verified date: April 2024
• Source: Peking Union Medical College Hospital
• Contact: kang ren, PhD
• Phone: +86-18810679890
• Email: kangren2021[@]126.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a prospective, single-center, phase II, randomized, window-of-opportunity trial initiated by researchers. The research hypothesis is that metformin can improve the level of hypoxia in locally advanced cervical cancer and further improve progression-free survival. The study aims to compare the improvement of tumor hypoxia with synchronous chemoradiotherapy with or without metformin, using CA-IX PET/CT and radiation positioning spectral CT to evaluate tumor hypoxia, screening hypoxic patients for inclusion in the study, and comparing the effects of synchronous chemoradiotherapy with or without metformin on the degree of hypoxia and progression-free survival in the two groups of patients.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 51
• Est. completion date: February 1, 2026
• Est. primary completion date: August 1, 2025
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 70 Years

Eligibility

Inclusion Criteria:

1. Ages 18-70 years old

2. Pathologically confirmed cervical squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma

3. FIGO stage IB2-IVA

4. Baseline CT or MRI indicating tumor necrosis (clinical hypoxia)

5. Hemoglobin =90g/L (blood transfusions allowed); no prior chemotherapy

6. ECOG performance status 0-2

7. No severe hematopoietic dysfunction, and no significant cardiac, pulmonary, hepatic, renal dysfunction, or immune deficiency

8. Able to undergo PET/CT imaging

9. Feasible for gynecological examination and cervical biopsy

10. Not pregnant or breastfeeding

Exclusion Criteria:

1. Renal insufficiency with eGFR <45 ml?min-1?1.73 m-2, and acute conditions that may lead to renal impairment such as dehydration, severe infectious diseases, shock, etc.

2. Diagnosed diabetes mellitus or current use of metformin or any other antidiabetic medication.

3. Concurrent diseases that may lead to tissue hypoxia (especially acute or exacerbated chronic conditions), such as acute heart failure, pulmonary fibrosis, respiratory failure, recent myocardial infarction, or blood pressure monitoring showing less than 90/60 mmHg, SpO2 <90%.

4. Serum transaminases exceeding 3 times the upper limit of normal, liver failure, alcohol poisoning.

5. History of allergic reactions to compounds chemically or biologically similar to metformin.

6. Concurrent hypoglycemia, such as insulinoma, autoimmune hypoglycemia, or functional hypoglycemia, or fasting blood glucose persistently less than 2.8 mmol/L before enrollment.

7. Malnutrition, BMI <18.5.

8. Concurrent unhealed gastric ulcer, duodenal ulcer, ulcerative colitis, Crohn's disease, or recent episodes of severe abdominal pain, diarrhea, vomiting, etc.

9. Concurrent rectovaginal fistula, vesicovaginal fistula, uncontrolled vaginal bleeding, or those at risk of fistula.

10. Inability to undergo intracavitary radiotherapy as assessed by the investigator.

11. Human immunodeficiency virus (HIV) infection.

12. Severe underlying diseases that are untreatable.

13. History of other malignant tumors (excluding cured basal cell carcinoma of the skin) or previous pelvic radiotherapy.

14. Currently participating in other clinical trials or stopped participating in clinical trials less than 4 weeks ago.

15. Neurological or psychiatric abnormalities affecting cognitive function.

Related Conditions & MeSH terms

• Cervical Cancer
• Hypoxia
• Metformin
• PET/CT
• Radiotherapy
• Uterine Cervical Neoplasms

Intervention

Drug:
• Metformin
Patients randomized to the metformin group will start taking metformin within 1 day after group allocation. They will take one tablet of metformin (850 mg) once daily for three consecutive days. Subsequently, they will take metformin orally twice daily throughout the entire external and internal irradiation period, with each administration consisting of one tablet.

Radiation:
• Radiotherapy
The study requires all subjects to sequentially undergo external beam radiotherapy (EBRT) and intracavitary brachytherapy (BT). All radiotherapy must be completed within 7-8 weeks after treatment initiation. The total prescribed dose EQD2 for EBRT combined with BT should be =80 Gy; for subjects with squamous carcinoma with lesions =4 cm, the HR-CTV D90 should be =80 Gy; for subjects with adenocarcinoma or lesions >4 cm, it is recommended that HR-CTV D90 should be =85 Gy. When the prescribed dose is limited by organs at risk (OAR), priority should be given to covering HR-CTV. The radiotherapy plan in this study is based on image guidance. Imaging scans can use MRI or CT, and the scanning area should extend at least 5 cm above and below the PTV.

Drug:
• Chemotherapy
The dosage of cisplatin is 40 mg/m2, administered once weekly during radiotherapy for a duration of 5 weeks. Prior to and following cisplatin administration, 1-2 liters of fluid should be given for adequate hydration. Treatment should continue until disease progression or intolerable toxicity occurs.

Diagnostic Test:
• PET/CT
Using 68Ga-NY104 as a small molecule targeted imaging agent for CA-IX, two CA-IX PET/CT scans will be conducted in patients: one upon enrollment and another one week after randomization.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Peking Union Medical College Hospital

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The degree to which metformin improves the hypoxic index measured by CAIX PET	Using the uptake value parameter of CA-IX in PET/CT, comparing the changes in uptake values between the two scans as an indicator of improvement in hypoxia level	1week after randomization
Secondary	Progression-free survival(PFS)	Progression-free survival is defined as the time from randomization to disease progression or death from any cause,whichever is first.	2-year
Secondary	Changes in tumor volume during treatment	Tumor volume will be measured via pelvic MRI.	Baseline,1month and 2 months.
Secondary	Hematologic and gastrointestinal toxicities assessed by CTCAE v5.0	Treatment-related toxicity reactions in both groups of patients will be evaluated during the treatment period, at the end of treatment, and three months after treatment completion	Up to 3 months after treatment.
Secondary	Quality of life assessed by QLQ-C30	Assessment of quality of life in both groups of patients	Up to 3 months after treatment